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37.106.1104    MEDICAL ASSISTANCE FACILITIES: MEDICAL STAFF

(1) The facility must have a medical staff that includes at least one physician, may also include one or more physician's assistants and/or nurse practitioners, and does the following:

(a) Examines the credentials of candidates for medical staff membership and makes recommendations to the governing board on the appointment of the candidate;

(b) Adopts bylaws containing the following, and enforces the bylaws after their approval by the governing body:

(i) A description of the qualifications a medical staff candidate must meet in order to be recommended to the governing body for appointment.

(ii) A statement of the duties and privileges of each category of medical staff (e.g., physician, physician's assistant, nurse practitioner) ; and

(iii) A requirement that a physical examination be made and medical history taken of a patient by a member of the medical staff no more than seven days before or 24 hours after the patient's admission to the facility.

(2) A physician on staff must:

(a) Provide medical direction for the facility's health care activities and consultation for, and medical supervision of, non-physician health care staff;

(b) In conjunction with the physician's assistant and/or nurse practitioner staff members, participate in developing, executing, and periodically reviewing the facility's written policies and the services provided patients;

(c) Review and sign the records of each patient admitted and treated by a physician's assistant or nurse practitioner no later than one month after that patient's discharge from the facility;

(d) Provide health care services to the patients in the facility, whenever needed and requested;

(e) Prepare guidelines for the medical management of health problems, including conditions requiring medical consultation and/or patient referral; and

(f) At intervals no more than 30 days apart, be physically present in the facility for a sufficient period of time to provide the medical direction, medical care services, staff consultation and supervision required by this rule, and when not present, either be available through direct telecommunication for consultation, assistance with medical emergencies, or patient referral, or ensure that another physician is available for the purpose; however, the physical site visit for a given 30-day period is not required if, during that period, no patients have been treated by the facility.

(3) A physician's assistant and/or nurse practitioner must:

(a) Participate in the development, execution, and periodic review of the guidelines and written policies governing the services furnished by the facility;

(b) Participate with a physician in a periodic review of each patient's health records;

(c) Provide health care services to patients in accordance with the facility's policies;

(d) Arrange for, or refer patients to, needed services that are not provided at the facility; and

(e) Assure that adequate patient health records are maintained and transferred as necessary when a patient is referred.

(4) A physician's assistant must keep on file at the facility and available for review by the department, upon request, a copy of his or her utilization plan currently approved by the board of medical examiners.

(5) At all times, either a physician, nurse practitioner, or physician assistant must be on duty or on call and available physically to the facility within one hour, unless the facility has implemented the procedure required by ARM 37.106.1103(c) (iv) to deal with occasions in which a practitioner is unavailable.

History: Sec. 50-5-103, MCA; IMP, Sec. 50-5-101, 50-5-103 and 50-5-204, MCA; NEW, 1989 MAR p. 663, Eff. 4/28/89; TRANS, from DHES, 2002 MAR p. 185.

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